Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
Department of Pathology, University of Rochester Medical Center, Rochester, New York.
Lab Invest. 2023 Nov;103(11):100234. doi: 10.1016/j.labinv.2023.100234. Epub 2023 Aug 21.
Coinfection with multiple high-risk human papillomavirus (hrHPV) is frequently observed in cervical specimens; however, the clinical significance of concomitant multiple hrHPV infections is poorly understood, and the published results remain inconsistent. A retrospective study at a tertiary care institution was performed, evaluating Tellgenplex human papillomavirus (HPV) 27 genotyping or YanengBio HPV 23 genotyping results and immediate cervical histologic diagnosis (within 6 months after HPV genotyping), between November 2015 and October 2022. Among 49,299 cases with hrHPV genotyping and histologic diagnosis, 24,361 cases were diagnosed as cervical intraepithelial neoplasia (CIN) and squamous cell carcinoma. Among women with cervical squamous lesions, 86.5% (21,070/24,361) had hrHPV infections, and concomitant multiple hrHPV infections accounted for 24.7% of hrHPV-positive cases (5210/21,070). The hrHPV-positive rates in these cervical squamous lesions increased progressively with disease severity; however, the percentages of concomitant multiple hrHPV infection rates among hrHPV-positive cases decreased significantly with increasing degree of squamous abnormalities. There was no increased detection rate of CIN3+ (CIN3 and squamous cell carcinoma) in cases with concomitant 2 or 3 hrHPV genotype infections when compared with those with corresponding single hrHPV infections. Conversely, some combinations of multiple hrHPV infections demonstrated a decrease in the detection rates of CIN3+ lesions. In this large cohort, our results demonstrated that multiple hrHPV infections do not carry an increased risk for developing CIN3+ lesions when compared to the corresponding single-genotype infection. The reduced risk of CIN3+ in women infected with some combinations of hrHPV genotypes compared to those with single-genotype infections supports the concept of intergenotypic competition of hrHPV genotypes in cervical squamous lesions.
在宫颈标本中经常观察到多种高危型人乳头瘤病毒（hrHPV）的合并感染；然而，同时存在多种 hrHPV 感染的临床意义尚不清楚，并且已发表的结果仍然不一致。对一家三级医疗机构进行了回顾性研究，评估了 Tellgenplex 人乳头瘤病毒（HPV）27 基因分型或 YanengBio HPV 23 基因分型结果以及即时宫颈组织学诊断（HPV 基因分型后 6 个月内），时间为 2015 年 11 月至 2022 年 10 月。在 49299 例有 hrHPV 基因分型和组织学诊断的病例中，24361 例诊断为宫颈上皮内瘤变（CIN）和鳞状细胞癌。在患有宫颈鳞状病变的女性中，86.5%（21070/24361）存在 hrHPV 感染，同时存在多种 hrHPV 感染占 hrHPV 阳性病例的 24.7%（5210/21070）。这些宫颈鳞状病变中的 hrHPV 阳性率随着疾病严重程度的增加而逐渐增加；然而，随着鳞状异常程度的增加，同时存在多种 hrHPV 感染的病例中同时存在多种 hrHPV 感染的比例显著降低。与相应的单一 hrHPV 感染相比，同时存在 2 种或 3 种 hrHPV 基因型感染的病例中，CIN3+（CIN3 和鳞状细胞癌）的检出率没有增加。相反，一些多重 hrHPV 感染的组合显示出 CIN3+病变的检出率降低。在这个大队列中，我们的结果表明，与相应的单一基因型感染相比，多重 hrHPV 感染并不会增加发展为 CIN3+病变的风险。与单一基因型感染相比，感染某些组合的 hrHPV 基因型的女性 CIN3+的风险降低，这支持了 hrHPV 基因型在宫颈鳞状病变中存在基因型间竞争的概念。
